High-dose-rate intraoperative brachytherapy and radical surgical resection in the management of recurrent head-and-neck cancer

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• 作者：Sewit Teckie¹ ; ^{teckies@mskcc.org} ; L. Matthew Scala¹ ; Felix Ho¹ ; Suzanne Wolden¹ ; Johnny Chiu¹ ; Gil'ad N. Cohen¹ ; Richard Wong² ; Ian Ganly² ; Michael J. Zelefsky¹ ; Nancy Y. Lee¹
• 关键词：Intraoperative radiation therapy ; Head and neck cancer ; Recurrence ; Salvage
• 刊名：Brachytherapy
• 出版年：2013
• 出版时间：May-June, 2013
• 年：2013
• 卷：12
• 期：3
• 页码：228-234
• 全文大小：176 K

文摘

Purpose

To report long-term outcomes of high-dose-rate (HDR) intraoperative radiotherapy (IORT) at the time of radical resection for recurrent head-and-neck cancer and determine potential prognostic factors.

Methods and Materials

Between 7/1998 and 11/2011, 57 patients with recurrent head-and-neck cancer underwent radical resection with curative intent and single-fraction IORT to 59 sites using a Harrison-Anderson-Mick applicator with remotely after-loaded ¹⁹²Ir HDR brachytherapy.

Results

One- and 3-year in-field progression-free survival (IFPFS) was 67 % and 57 % , respectively. In a multivariate model, IORT dose >15 Gy (hazard ratio [HR]?=?0.11; p?=?0.02), and prerecurrence disease-free interval >12 months (HR?=?0.29; p?=?0.04) independently predicted for superior IFPFS; nodal extracapsular extension (HR = 4.62; p = 0.003) predicted for inferior IFPFS. Three-year overall survival (OS) was 50 % vs. 32 % in those achieving in-field control vs. those not achieving in-field control (p?=?0.04). Grade 3+ toxicity occurred in 37 % and was unrelated to IORT dose.

Conclusions

HDR-IORT combined with radical surgical resection is associated with durable IFPFS and long-term overall survival in select patients with acceptable treatment-related morbidity. IORT dose >15 Gy should be used to increase the likelihood of disease control. The ability to achieve in-field local control in this poor prognostic cohort was associated with improved survival outcomes.